Fueling RN Professional Growth

What nurses expect from their leaders is changing. Gone are the days of command and control leadership when staff was supposed to be grateful because they had a job. Today’s nurses want their leaders to be coaches who will help them learn and grow as professionals. In the recently published book, It’s the Manager, Gallup researchers analyzed decades of survey data and found that the very best managers are coaches (Clifton & Harter, 2019). They also discovered that both millennials and Generation Z want their leaders to be coaches, not bosses. These findings are supported in work published by Google (n.d.) indicating that one of the most important behaviors of their highest scoring managers is that they are effective coaches. The message is clear: Coaching is no longer a specialty that can be outsourced. You cannot be a good manager without being a coach.

Coaching is a different approach to developing the potential of staff. When you coach, you provide staff with the opportunity to grow and gain expertise through more consistent feedback, counseling and mentoring. Sir John Whitmore (2017), an expert in executive coaching, defines coaching as unlocking potential to maximize performance. The goal is to help others learn through self-exploration rather than teaching. When coaching, the relationship moves from being dominated by the leader to a partnership with staff. You don’t wait until the annual review to discuss areas in need of improvement. The effective leader coach takes the time to understand the motivations of individual staff, enables optimal performance, encourages professional success and removes barriers to high-level performance.

Many leaders believe they currently coach staff and may not see a need to develop this skill set. However, Gallup data indicates that one-half of the workforce report they receive minimal coaching (Clifton & Harter, 2019). Milner and Milner (2018) found in their research that managers think they are coaching when in fact they are telling their employees what to do. Their most significant takeaway from observing managers coaching staff was that instead of coaching, they reverted to a form of consulting. Essentially, they provided the other person with advice or a solution. They regularly heard comments like, “First you do this” or “Why don’t you do this?” With skill building, feedback and commitment, these managers were able to build their coaching skills. This article includes guidance on how to develop a leader coach mindset, essential coaching skills, the potential impact on organizational outcomes and how the coaching habit can be hardwired.

A shift in mindset

Transitioning from a traditional manager to a nurse leader coach requires a different mindset and skill set to add to your leadership toolbox (Figure 1). When coaching, leaders need to adopt a growth mindset (Dweck, 2016). This enables the leader coach to be more open to the potential of nursing staff and attentive to which innate talents of individuals can be maximized. No one’s full potential is known or knowable; there is always room for growth. Modeling a growth mindset in coaching helps staff who are coached to experience failure less emotionally. The leader coach focuses on learning from mistakes versus letting the nurse fuel negative personal narratives.

Figure 1: The traditional Manager versus the Nurse Leader Coach

The coaching effort is not directed at “fixing” and more towards understanding. Support is offered along with challenge; empathy goes with accountability. The key characteristics of a coaching leadership approach include partnership and collaboration versus command and control. It involves less time talking and more time listening.

Good leader coaches also do the following:

• Maintain awareness of their personal biases and reflect on their assumptions.
• Facilitate two-way discussions where the staff member does most of the talking.
• Structure conversations to be timely and solution focused.
• Avoid being the advice monster and let team members choose their next steps.

Key coaching skills

Effective coaching usually involves developing new skills and eliminating some bad habits. Most nurse leaders are selected for a leadership role because of their excellent problem-solving skills in clinical practice. It is not surprising that managers see themselves as problem fixers because this is how they have added value in their roles. However, when you move into leadership, your success depends on the success of others, and that requires coaching. To shift to becoming a leader coach, you need to resist the temptation to solve the problems of your staff and instead help them to develop their own solutions. Raymond (2018) recommends that leaders should be less Superman and more Yoda. The Yoda is there to coach and support staff but will not solve all their problems. The Yoda is okay with things not being done their way and recognizes that mistakes will be part of the learning process. When confronted with issues brought to them by staff, the Yoda asks questions that point staff in the right direction but does not give them the solution.

Five core coaching skills include:

1. Be fully present in conversations with staff and avoid looking at communication devices.
2. Practice active listening and aim for talking only 20% of the time in coaching conversations.
3. Ask open-ended questions and recognize that the power of coaching is in the questions that you ask, such as: What’s on your mind? Wait for a response and then ask—and what else?
4. Practice direct communication by helping staff to identify self-limiting beliefs, blind spots, or reframe perspectives.
5. Promote follow-up accountability for goals set and maintain a feedback loop.

One of the most widely used coaching models is the four-stage GROW framework (Whitmore, 2017). In the first stage, a goal or goals the nurse wants or needs to achieve are established. Stage two involves a discussion about the current reality of the situation with a focus on what needs to change to achieve the goal. The third stage is a discussion of the possible options and pathways to goal achievement. The final stage is the way forward where the nurse commits to taking specific actions to goal achievement, and a timeline is established. Three opportunities for coaching conversations in nursing are professional development, performance development and career coaching. Using the GROW model provides a structured way of conducting coaching conversations in any of these areas, leading to tremendous value to both the nurse and the organization.

Organizational impact

Leader coaching has the potential to impact organizational outcomes in four key areas. The first is nurse engagement. Data from a 2017 State of the American Workplace Report from the Gallup organization indicates that only 33% of U.S. employees are engaged in their work; the others are either not engaged or actively disengaged. These trends are consistent with nationwide research conducted by the Advisory Board (2014), which found that only 32.6% of RNs are engaged in their work, and 7.4% are actively disengaged. Gallup research data attributes 70% of the variance seen in staff engagement directly to the leadership of the frontline manager (Wigert & Harter, 2017). One of the most compelling reasons to become a nurse leader coach is the impact coaching can have on nurse engagement. RNs want an authentic relationship with their managers that includes talk about both work and life. They want to work somewhere that values their strengths and invests in their ongoing development. Staff who agree that their manager involves them in goal setting are four times more engaged than other employees (Wigert & Harter, 2017).

Nurse retention is a second area where coaching has the potential to improve organizational performance. RN turnover now averages $52,100 per nurse, with the typical hospital in the U.S. losing between $4.4 million and $6.9 million each year in turnover costs (NSI, 2019). Frontline nurse leaders are the linchpin in staff recruitment and retention (Ulrich, Barden, Cassidy & Varn-Davis, 2019a). When considering career opportunities, nurses now look at whether leaders are supportive of their professional and career goals. They desire frequent feedback and want leaders who help them become the best versions of themselves. When these expectations are not met, younger nurses will leave their organizations as evidenced by the increased RN turnover nationwide to 17.2% in 2018 (NSI, 2019). Good coaching may, at times, also involve tough but helpful feedback that prevents young nurses from derailing in their roles and possibly leaving the profession. Timely feedback coupled with future-oriented coaching about performance development needs is perceived by staff as being more constructive and less punitive (Wigert & Harter, 2017).

Creation of healthy work environments is a growing concern in nursing (Ulrich, Barden, Cassidy & Varn-Davis, 2019b), and an additional area where nurse leader coaching can have organizational impact. Coaching helps to build a learning culture where there is a commitment to co-creation and co-learning between the leader and the staff member. Coaching interventions can be effectively used to directly confront bullying behaviors and fortify against horizontal violence on units. Nurse leader coaching can help staff feel more psychologically safe in their environments, which is a key component of a healthier work environment.

A final way that coaching can impact organizations is through improved patient outcomes. A 2017 Press Ganey study examining the impact of nurse managers on outcomes found that nurse manager support exerts substantial influence on the work environment of nurses. Variances in the quality of work environments were found to impact performance measures in areas such as safety, quality and the patient experience. Nurse managers also found to have strong impact in most clinical areas on job enjoyment and intent to stay which translates to the development of higher reliability units. Nurse leader coaches who give frequent feedback make it safe for nurses to report challenges and problems that can then be quickly fixed.

Hardwiring the coaching habit

Given their many leadership role demands and span of control, frontline leaders may feel that they don’t have the time to coach. If you reframe your thinking about the importance of coaching from a “nice to do” to a “must do,” time will not be a problem. Health care organizations face fierce competition for good talent. If you commit yourself to be a leader coach, you could considerably decrease the time that you spend recruiting new staff and overall labor costs to your organization. Each percent change in RN turnover can save or cost a hospital an additional $328,400 per year (NSI, 2019).

Any new change in behavior is a change in work habits and can be challenging until it becomes routine. Coaching thought leader Michael Bungay Stanier (2016) has noted that this stuff sounds simple, but it is not easy. The best way to start is to look for ways to embed quick-connect and check-in coaching conversations with staff into your current leadership activities such as team huddles, leadership rounding or staff meetings. Commit to doing at least four brief coaching discussions with staff each day. These conversations don’t need to be long, but they do need to be authentic. Choose a few go-to questions that are comfortable for you to open the conversation with staff.

Examples of good kick-starter coaching questions include:

• What’s on your mind?
• What is the real challenge here for you?
• What matters most to you in your practice?
• What talents do you know you have but are not using?
• How can you do more of the work you love?
• And what else?
• What is the most important thing you have learned about yourself as a new graduate?
• What will make you happy?
• What actions do you need to take but are avoiding?
• What are the best sources of feedback for you to measure your progress?

Research indicates a leader’s behavior has a significant impact on staff performance. Gallup recommends that if organizations could prioritize only one leadership action to improve performance, it should equip their managers to be coaches (Clifton & Harter, 2019). Adopting a leader coach mindset can lead to higher levels of both individual and team performance through the fostering of independence and interdependence. Coaching is a skill set that can be learned, but takes it practice and intentionality. An organizational culture committed to leader coaching has the potential for a strong return on investment through nurse retention, improved staff engagement, creation of healthier work environments and better patient outcomes.

References

Advisory Board. (2014). National Prescription for Nurse Engagement. Retrieved from https://www.advisory.com/research/nursing-executive-center/

Clifton, J., & Harter, J. (2019). It’s the manager: Gallup finds the quality of managers and team leaders is the single biggest factor in your organization’s long-term success. New York, NY: Gallup Press.

Dweck, C. S. (2016). Mindset: The New Psychology of Success. New York, NY: Random House.

Gallup. (2017). State of the Global Workplace. Retrieved from https://www.gallup.com/workplace/238079/state-global-workplace-2017.aspx

Google Guide: Identify what makes a great manager. (n.d.). Retrieved from https://rework.withgoogle.com/subjects/managers/

Milner, J., & Milner, T. (2018, August 14). Most managers don’t know how to coach people. But they can learn. Harvard Business Review. Retrieved from https://hbr.org/2018/08/most-managers-dont-know how-to-coach-people-but-they-can-learn

NSI Nursing Solutions. (2019). National Healthcare Retention & RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/2019%20National%20Health%20Care%20Retention%20Report.pdf

Press Ganey. (2017). Nursing special report: The influence of nurse manager leadership on patient and nurse outcomes and the mediating effects of the nurse work environment. Retrieved from https://www.pressganey.com/about/news/nursing-special-report-the-influence-of-nurse-work-environment-on-patient-payment-and-nurse-outcomes

Raymond, J. (2018). Good authority: How to become the leader your team is waiting for. Washington, D.C.: IdeaPress Publishing.

Stanier, M. B. (2016). The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever. Toronto, ON: Box of Crayons Press.

Ulrich, B., Barden, C., Cassidy, L., & Varn-Davis, N. (2019a). Frontline nurse manager and chief nurse executive skills: Perceptions of direct care nurses. Nurse Leader, 17(2),109-112. doi:10.1016/j.mnl.2018.12.014

Ulrich, B., Barden, C., Cassidy, L., & Varn-Davis, N. (2019b). Critical care nurse work environments 2018: Findings and implications. Critical Care Nurse, 39(2), 67-84. doi:10.4037/ccn2019605

Whitmore, J. (2017). Coaching for Performance: The Principles and Practice of Coaching and Leadership. London, England: Nicholas Brealey.

Wigert, B., & Harter, J. (2017). Re-engineering performance management. Retrieved from https://www.gallup.com/workplace/238064/re-engineering-performance management.aspx+

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